Spondylolysis (spon-dee-low-lye-sis) is a stress fracture of a section of the lumbar spine; most frequently the fifth vertebrae. The injury can occur on the left, the right, or both sides of the vertebrae. Highly active teens, both boys and girls who engage in activities that require lifting heavy loads, repeated backward bending of the back, or twisting of the trunk, are most at risk for spondylolysis, including athletes participating in activities like football, hockey, gymnastics, or dance. Our skilled physical therapists at Progressive Physical Therapy use the latest scientific evidence combined with years of experience to design customized programs that relieve pain, manage symptoms and get you back in action in the quickest timeframe possible.

Spondylolysis is a stress fracture of the pars interarticularis, part of the bony ring that connects the front part of the spinal column to its back portion. Specifically, the fracture occurs between the spinous process (bony protrusion that sticks out the back of the spine) and the transverse process (bony protrusion that sticks out of the side of the spine). Excessive strain on the lumbar vertebrae due to repetitive activities in a growing child can cause injury to the vertebrae, resulting in low back pain.

Spondylolisthesis is the forward slip of a defective, unstable vertebrae. There are five grades of slips, with grade I being the smallest amount of slip and grade V being a slip of 100%. Nonsurgical management is most successful with patients who have a defect on only 1 side of the vertebrae and those patients with a grade II or less slip. Young athletes whose adolescent growth spurt has not yet occurred are at greater risk for continued slippage and are monitored until they stop growing.

Key points to understand about spondylolysis and spondylolisthesis:

• Early detection and proper diagnosis of these conditions is important because return to sport or an active lifestyle can occur within 3 to 6 months with early diagnosis. With prolonged symptoms and a delayed diagnosis, healing may take up to a year.
• The majority of symptoms resolve with rest, with or without the use of a back brace or activity modifications.
• Surgery may be indicated when conservative treatment of greater than 6 months fails and debilitating symptoms persist.
• Spondylolysis and spondylolisthesis need to be ruled out in a young athlete who is experiencing low back pain for more than a few weeks. Active young athletes who participate in sports, such as football, hockey, gymnastics, and dance are at the greatest risk of developing the conditions, especially while growing.
• A negative x-ray reading requires additional imaging to rule out early injury to the vertebrae if clinical exam findings suggest a high probability of spondylolysis.
• Spondylolysis and spondylolisthesis are not a major cause of low back pain in adults, except in high-level athletes engaging in high-risk sports.

In the beginning, when you are in pain and having difficulty performing your normal daily routine, our physical therapists at Progressive Physical Therapy can:

• Show you how to rest the injured vertebrae, use lumbar bracing, modify your activities, and avoid painful movements
• Help you reduce and manage your pain symptoms
• Help you maintain fitness while healing, through pain-free cross-training, such as aquatic therapy
• Initiate symptom-free hamstring stretching and activation of your core muscles, either in or out of a back brace

When you are pain free, and the healing of your injured structures has begun, your physical therapist can help you:

• Improve the flexibility of your hip and leg muscles
• Improve your core and leg strength
• Improve your spine flexibility
• Prepare for a return to sport or work activities by improving your overall fitness levels
• Begin a gradual progression of higher-risk movements, such as back extension and trunk rotation to reduce the chance of reinjury

Our physical therapists provide education, pain reduction, activity modification, and cross-training to aid healing for patients with these conditions. We can help you increase your spine and leg flexibility, strengthen your core muscles, and return to your sport, work, and recreational activities without a recurrence of symptoms.